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three years. CDC has provided vaccinia vaccine for these laboratory workers since 1983.1 In 1991, ACIP further expanded smallpox vaccination recommendations to include healthcare workers involved in clinical trials using recombinant vaccinia virus vaccines and lengthened the recommendations for revaccination for persons working with vaccinia virus, recombinant vaccinia viruses, or other nonvariola orthopoxviruses to every 10 years.

In June 2001, ACIP made recommendations for use of smallpox (vaccinia) vaccine to protect persons working with orthopoxviruses, and to prepare for a possible bioterrorism attack involving smallpox. Because of the fall 2001 terrorist attacks, CDC asked ACIP to again review and update its previous recommendations for smallpox (vaccinia) vaccination. As a result of this review, ACIP issued supplemental recommendations for vaccination of 1) the general population and 2) persons designated to respond or care for a suspected or confirmed case of smallpox. In addition, the proposed policy clarified and expanded the primary strategy for control and containment of smallpox in the event of an outbreak.

To supplement this review process, CDC asked the Institute of Medicine (IOM) of the National Academy of Sciences (NAS) to convene a public conference to discuss the scientific, clinical, procedural, and administrative aspects of various immunization strategies. This report summarizes the discussions of that meeting. Held on June 15, 2002 in Washington, D.C., the meeting was expository, not deliberative, and its discussions and conclusions do not reflect the opinions of either IOM or the NAS.


The threat of smallpox has not changed appreciably since ACIP last reviewed smallpox immunization policy in June 2001. It remains difficult to obtain the virus, prepare it, and distribute it. What has changed is the availability of vaccine.

Dryvax, the vaccinia (smallpox) vaccine currently licensed in the United States, is a lyophilized, live-virus preparation of infectious vaccinia virus, produced in 1975 by Wyeth Laboratories, Inc., of Marietta, Pennsylvania. Vacciniad vaccine does not contain smallpox (variola) virus. Previously, the vaccine had been prepared from calf lymph with a seed virus derived from the New York City Board of Health strain of vaccinia virus. Vaccine was administered by us


After the anthrax attacks of 2001, CDC formed smallpox response teams of 200 people, who were vaccinated with vaccinia. In late November 2001, a smallpox interim response plan was developed, as was a rash algorithm, followed by intensive training of 700 people.


The opening remarks for the meeting were presented by D.A.Henderson from Johns Hopkins University.

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